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Case Reports
. 2016 Jun 3;7(Suppl 15):S431-3.
doi: 10.4103/2152-7806.183541. eCollection 2016.

A refractory arachnoid cyst presenting with tremor, expressive dysphasia, and cognitive decline

Nathan T Zwagerman  1 , Jamie Pardini  1 , Seyed H Mousavi  1 , Robert M Friedlander  1
Affiliations
Case Reports

A refractory arachnoid cyst presenting with tremor, expressive dysphasia, and cognitive decline

Nathan T Zwagerman et al. Surg Neurol Int. .

Abstract

Background: Arachnoid cysts are common incidental findings on intracranial imaging, although they are rarely symptomatic.

Case description: We present a case of a 49 year-old woman with a recurrent left supraorbital arachnoid cyst who developed staring spells, expressive dysphasia, and tremor after cyst fenestration and cystoperitoneal shunting. Her symptoms resolved after removing the shunt valve and creating a valveless system. The case is discussed and the literature reviewed.

Conclusion: We present a case of a recurrent arachnoid cyst that developed worsening and new symptoms after cysto-peritoneal shunting with a programmable valve, which reducing the pressure in the cyst resulted in remarkable resolution of her symptoms.

Keywords: Arachnoid cyst; cystoperitoneal shunt; optic nerve; seizures; tremor; valve-less shunt.

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Figures

Figure 1
Figure 1
(a) T2 axial and coronal weighted magnetic resonance imaging depicting the preoperative arachnoid cyst located in the left supraorbital region compressing the left optic nerve, optic chiasm, internal carotid artery, and middle cerebral artery. (b) T2-weighted axial and T1 with contrast magnetic resonance imaging taken after left pterional craniotomy following fenestration of the cyst with near complete resolution of the cyst and patient symptoms
Figure 2
Figure 2
(a) T2-weighted axial and T1 with contrast coronal magnetic resonance imaging depicting a recurrent arachnoid cyst 3 years after surgical intervention for first cyst. (b) Sequential axial computed tomography images and coronal computed tomography image indicating the location of the cystoperitoneal shunt within the now obliterated cyst. Note: The catheter is not intraparenchymal but rather traveling on the skull base
See this image and copyright information in PMC

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